Radiation therapy for carcinoma of the nasal vestibule

From 1963 to 1984, 32 patients with squamous cell carcinoma of the nasal vestibule received definitive radiation therapy. Of these, 11 patients whose superficial lesions were suitably located received radium implants, and the other 21 patients were treated with a combination of electron beam and 60Co. The implant doses ranged from 60 to 75 Gy and the external beam doses ranged from 55 to 70 Gy. In 12 patients, the submandibular and subdigastric nodes were electively treated with 60Co with doses of 45 to 50 Gy, and in 12 patients the strip of skin between the nose and the free border of the mandible was also electively irradiated. None of the 11 patients treated by interstitial implant experienced treatment failure. In the 21 patients treated by external beam, one patient had primary tumor recurrence and four patients failed in the unirradiated neck. A metastasis developed in the unrradiated tissues between the nose and the neck on the only patient who died of the disease. Necrosis of the anterior art of the upper jaw of one patient developed as a result of a hot spot. Today, when treatment is calculated with the help of a computer program and special techniques to optimize tumor dose, hot spots can be prevented.